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Etiological profile and treatment outcome of epistaxis at a tertiary care hospital in Northwestern Tanzania: a prospective review of 104 cases
Japhet M Gilyoma, Phillipo L Chalya
BMC Ear, Nose and Throat Disorders , 2011, DOI: 10.1186/1472-6815-11-8
Abstract: This was a prospective descriptive study of the cases of epistaxis managed at Bugando Medical Centre from January 2008 to December 2010. Data collected were analyzed using SPSS computer software version 15.A total of 104 patients with epistaxis were studied. Males were affected twice more than the females (2.7:1). Their mean age was 32.24 ± 12.54 years (range 4 to 82 years). The modal age group was 31-40 years. The commonest cause of epistaxis was trauma (30.8%) followed by idiopathic (26.9%) and hypertension (17.3%). Anterior nasal bleeding was noted in majority of the patients (88.7%). Non surgical measures such as observation alone (40.4%) and anterior nasal packing (38.5%) were the main intervention methods in 98.1% of cases. Surgical measures mainly intranasal tumor resection was carried out in 1.9% of cases. Arterial ligation and endovascular embolization were not performed. Complication rate was 3.8%. The overall mean of hospital stay was 7.2 ± 1.6 days (range 1 to 24 days). Five patients died giving a mortality rate of 4.8%.Trauma resulting from road traffic crush (RTC) remains the most common etiological factor for epistaxis in our setting. Most cases were successfully managed with conservative (non-surgical) treatment alone and surgical intervention with its potential complications may not be necessary in most cases and should be the last resort. Reducing the incidence of trauma from RTC will reduce the incidence of emergency epistaxis in our centre.Epistaxis or nasal bleeding is recognized as one of the most common otorhinolaryngological emergencies worldwide and presents a challenge in resource-poor centres where facilities for caring of these patients are limited [1]. Epistaxis is a problem frequently encountered in general practice and may present as an emergency, as a chronic problem of recurrent bleeds or may be a symptom of a generalized disorder [2]. It cannot only affect the hemodynamic but may cause great anxiety to patients and their relatives.E
Endoscopic procedures for removal of foreign bodies of the aerodigestive tract: The Bugando Medical Centre experience
Japhet M Gilyoma, Phillipo L Chalya
BMC Ear, Nose and Throat Disorders , 2011, DOI: 10.1186/1472-6815-11-2
Abstract: This was a prospective descriptive study which was conducted at Bugando Medical Centre between January 2008 and December 2009. Data were collected using a structured questionnaire and analyzed using SPSS computer software version 15.A total of 98 patients were studied. Males outnumbered females by a ratio of 1.1:1. Patients aged 2 years and below were the majority (75.9%). The commonest type of foreign bodies in airways was groundnuts (72.7%) and in esophagus was coins (72.7%). The trachea (52.2%) was the most common site of foreign body's lodgment in the airways, whereas cricopharyngeal sphincter (68.5%) was the commonest site in the esophagus. Rigid endoscopy with forceps removal under general anesthesia was the main treatment modality performed in 87.8% of patients. The foreign bodies were successfully removed without complications in 90.8% of cases. Complication rate was 7.1% and bronchopneumonia was the most common complication accounting for 42.8% of cases. The mean duration of hospital stay was 3.4 days and mortality rate was 4.1%.Aerodigestive tract foreign bodies continue to be a significant cause of childhood morbidity and mortality in our setting. Rigid endoscopic procedures under general anesthesia are the main treatment modalities performed. Prevention is highly recommended whereby parents should be educated to keep a close eye on their children and keep objects which can be foreign bodies away from children's reach.Foreign bodies in the aerodigestive tract are an important cause of morbidity and mortality in the two extremes of life and pose diagnostic and therapeutic challenges to otorhinolaryngologists [1]. The ingestion and inhalation of foreign bodies occurs most commonly in children's population, especially in their first six years of life [2,3], with a peak incidence in children between 1 and 3 years [1,4]. Children are naturally susceptible to be involved in FB injuries due to lack of molar teeth, the tendency to oral exploration and to play dur
Ten-year experiences with Tracheostomy at a University teaching hospital in Northwestern Tanzania: A retrospective review of 214 cases
Japhet M Gilyoma, Darius D Balumuka, Phillipo L Chalya
World Journal of Emergency Surgery , 2011, DOI: 10.1186/1749-7922-6-38
Abstract: This was a 10-year retrospective study which was conducted at Bugando Medical Centre from January 2001 to December 2010. Data were retrieved from patients' files kept in the Medical record department and analyzed using SPSS computer software version 15.0. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study.A total of 214 patients were studied. The male to female ratio was 3.1: 1. The majority of patients were in the 3rd decade of life. The most common indication for tracheostomy was upper airway obstruction secondary to traumatic causes in 55.1% of patients, followed by upper airway obstruction due to neoplastic causes in 39.3% of cases. The majority of tracheostomies (80.4%) were performed as an emergency. Transverse skin crease incision was employed in all the cases. Post-tracheostomy complication rate was 21.5%. Complication rate was significantly higher in emergency tracheostomy than in electives (P < 0.001). The duration of temporary tracheostomy ranged from 8 days to 46 months, with a median duration of 4 months. Tracheostomy decannulation was successively performed in 72.4% of patients who survived. Mortality rate was 13.6%. The mortality was due to their underlying illnesses, none had tracheostomy-related mortality.Upper airway obstruction secondary to trauma and laryngeal tumors still remains the most common indication for tracheostomy in our centre and tracheostomy is still a life saving procedure in the surgical management of airway despite complications which are seen more commonly in paediatric patients. Most of tracheostomy related complications can be avoided by meticulous attention to the details of the technique and postoperative tracheostomy care by skilled and trained staff.Tracheostomy, an ancient surgical procedure originally described in the first century BC [1], is one of the more commonly performed surgical procedures in critically ill patients who require prolonged mechanical ventil
Animal-related injuries in a resource-limited setting: experiences from a Tertiary health institution in northwestern Tanzania
Gilyoma Japhet M,Mabula Joseph B,Chalya Phillipo L
World Journal of Emergency Surgery , 2013, DOI: 10.1186/1749-7922-8-7
Abstract: Background Animal related injuries are a major but neglected emerging public health problem and contribute significantly to high morbidity and mortality worldwide. No prospective studies have been done on animal related injuries in our setting. This study was conducted to determine the management patterns and outcome of animal related injuries and their social impact on public health policy in the region. Methods This was a descriptive prospective study of animal related injury patients that presented to Bugando Medical Centre between September 2007 and August 2011. Statistical data analysis was done using SPSS computer software version 17.0. Results A total of 452 (8.3%) animal-related injury patients were studied. The modal age group was 21-30 years. The male to female ratio was 2.1:1. Dog-bites (61.1%) were the most common injuries. Musculoskeletal (71.7%) region was the most frequent body region injured. Soft tissue injuries (92.5%) and fractures (49.1%) were the most common type of injuries sustained. Only 140 (31.0%) patients were hospitalized and most of them (97.1%) were treated surgically. Wound debridement was the most common procedure performed in 91.2% of patients. Postoperative complication rate was 15.9%, the commonest being surgical site infections (SSI) in 55.1% of patients. SSI was significantly associated with late presentation and open fractures (P < 0.001). The overall median duration of hospitalization was 16 days. Patients who had severe injuries, long bone fractures and those with hemiplegia stayed longer in the hospital (P < 0.001). Mortality rate was 10.2% and was significantly high in patients with severe injuries, severe head injury, tetanus and admission SBP < 90 mmHg (P < 0.001). The follow up of patients was poor. Conclusion Animal related injuries constitute a major public health problem in our setting and commonly affect the young adult male in their economically productive age-group. Measures towards prevention and proper treatment and follow up are important in order to reduce morbidity and mortality resulting from this form of trauma
Etiological spectrum, injury characteristics and treatment outcome of maxillofacial injuries in a Tanzanian teaching hospital
Phillipo L Chalya, Mabula Mchembe, Joseph B Mabula, Emanuel S Kanumba, Japhet M Gilyoma
Journal of Trauma Management & Outcomes , 2011, DOI: 10.1186/1752-2897-5-7
Abstract: A prospective hospital based study of maxillofacial injury patients was carried out at Bugando Medical Centre from November 2008 to October 2009. Data was collected using a structured questionnaire and analyzed using SPPS computer software version 11.5.A total of 154 patients were studied. Males outnumbered females by a ratio of 2.7:1. Their mean age was 28.32 ± 16.48 years and the modal age group was 21-30 years. Most injuries were caused by road traffic crushes (57.1%), followed by assault and falls in 16.2% and 14.3% respectively. Soft tissue injuries and mandibular fractures were the most common type of injuries. Head/neck (53.1%) and limb injuries (28.1%) were the most prevalent associated injuries. Surgical debridement (95.1%) was the most common surgical procedures. Closed reduction of maxillofacial fractures was employed in 81.5% of patients. Open reduction and internal fixation was performed in 6.8% of cases. Complications occurred in 24% of patients, mainly due to infection and malocclusion. The mean duration of hospital stay was 18.12 ± 12.24 days. Mortality rate was 11.7%.Road traffic crashes remain the major etiological factor of maxillofacial injuries in our setting. Measures on prevention of road traffic crashes should be strongly emphasized in order to reduce the occurrence of these injuries.The maxillofacial region occupies the most prominent position in the human body and rendering it vulnerable to injuries quite commonly [1]. Maxillofacial injuries are commonly encountered in the practice of emergency medicine and are often associated with high morbidity resulting from increased costs of care and varying degrees of physical, functional and cosmetic disfigurement [2]. It is estimated that more than 50% of patients with these injuries have multiple trauma requiring coordinated management between emergency physicians and surgical specialists in otolaryngology, trauma surgery, plastic surgery, ophthalmology, and oral and maxillofacial surgery [3,4]. M
Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience
Phillipo L Chalya, Joseph B Mabula, Geofrey Giiti, Alphonce B Chandika, Ramesh M Dass, Mabula D Mchembe, Japhet M Gilyoma
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-59
Abstract: A prospective descriptive study of splenic injury patients was carried out at Bugando Medical Centre in Northwestern Tanzania between March 2009 and February 2011. Statistical data analysis was done using SPSS software version 17.0.A total of 118 patients were studied. The male to female ratio was 6.4:1. Their ages ranged from 8 to 74 years with a median age of 22 years. The modal age group was 21-30 years. The majority of patients (89.8%) had blunt trauma and road traffic accidents (63.6%) were the most frequent cause of injuries. Most patients sustained grade III (39.0%) and IV (38.1%) splenic injuries. Majority of patients (86.4%) were treated operatively with splenectomy (97.1%) being the most frequently performed procedure. Postoperative complications were recorded in 30.5% of cases. The overall length of hospital stay (LOS) ranged from 1 day to 120 days with a median of 18 days. Mortality rate was 19.5%. Patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with associated injuries stayed longer in the hospital (P < 0.001), whereas age of the patient, associated injuries, trauma scores (KTS II), grade of splenic injuries, admission systolic blood pressure ≤ 90 mmHg, estimated blood loss > 2000 mls, HIV infection with CD4 ≤ 200 cells/μl and presence of postoperative complications were significantly associated with mortality (P < 0.001).Trauma resulting from road traffic accidents (RTAs) remains the most common cause of splenic injuries in our setting. Most of the splenic injuries were Grade III & IV and splenectomy was performed in majority of the cases. Non-operative management can be adopted in patients with blunt isolated and low grade splenic injuries but operative management is still indispensable in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of splenic injuries in our centre.The spleen is the most frequently injured organ in blunt abdominal trauma, an
Pattern of childhood burn injuries and their management outcome at Bugando Medical Centre in Northwestern Tanzania
Phillipo L Chalya, Joseph B Mabula, Ramesh M Dass, Geofrey Giiti, Alphonce B Chandika, Emmanuel S Kanumba, Japhet M Gilyoma
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-485
Abstract: A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0.A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (48.0%) sustained superficial burns. Eight (2.3%) patients were HIV positive. Most patients (89.8%) presented to the hospital later than 24 h. The rate of burn wound infection on admission and on 10th day were 32.4% and 39.8% respectively.Staphylococcus aureus were more common on admission wound swabs, with Pseudomonas aeruginosa becoming more evident after 10th day. MRSA was detected in 19.2% of Staphylococcus aureus. Conservative treatment was performed in 87.1% of cases. Surgical treatment mainly skin grafting (65.9%) was performed in 44 (12.9%) of patients. The overall average of the length of hospital stay (LOS) was 22.12 ± 16.62 days. Mortality rate was 11.7%. Using multivariate logistic regression analysis; age of the patient, type of burn, delayed presentation, clothing ignition, %TBSA and severity of burn were found to be significantly associated with LOS (P < 0.001), whereas mortality rate was found to be independently and significantly related to the age of the patient, type of burn, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (P < 0.001).Childhood burn injuries still remain a menace in our environment with virtually unacceptable high morbidity and mortality. There is need for critical appraisal of the preventive measures and management principles currently being practiced.Burn injuries constitut
Major limb amputations: A tertiary hospital experience in northwestern Tanzania
Phillipo L Chalya, Joseph B Mabula, Ramesh M Dass, Isidori H Ngayomela, Alphonce B Chandika, Nkinda Mbelenge, Japhet M Gilyoma
Journal of Orthopaedic Surgery and Research , 2012, DOI: 10.1186/1749-799x-7-18
Abstract: This was a descriptive cross-sectional study that was conducted at Bugando Medical Centre between March 2008 and February 2010. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS version 11.5 computer software.A total of 162 patients were entered into the study. Their ages ranged between 2–78？years (mean 28.30？±？13.72？days). Males outnumbered females by a ratio of 2:1. The majority of patients (76.5%) had primary or no formal education. One hundred and twelve (69.1%) patients were unemployed. The most common indication for major limb amputation was diabetic foot complications in 41.9%, followed by trauma in 38.4% and vascular disease in 8.6% respectively. Lower limbs were involved in 86.4% of cases and upper limbs in 13.6% of cases giving a lower limb to upper limb ratio of 6.4:1 Below knee amputation was the most common procedure performed in 46.3%. There was no bilateral limb amputation. The most common additional procedures performed were wound debridement, secondary suture and skin grafting in 42.3%, 34.5% and 23.2% respectively. Two-stage operation was required in 45.4% of patients. Revision amputation rate was 29.6%. Post-operative complication rate was 33.3% and surgical site infection was the most common complication accounting for 21.0%. The mean length of hospital stay was 22.4？days and mortality rate was 16.7%.Complications of diabetic foot ulcers and trauma resulting from road traffic crashes were the most common indications for major limb amputation in our environment. The majority of these amputations are preventable by provision of health education, early presentation and appropriate management of the common indications.
Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania
Phillipo L Chalya, Joseph B Mabula, Ramesh M Dass, Nkinda Mbelenge, Isdori H Ngayomela, Alphonce B Chandika, Japhet M Gilyoma
Journal of Trauma Management & Outcomes , 2012, DOI: 10.1186/1752-2897-6-1
Abstract: This was a prospective hospital based study of road traffic crash victims carried out at Bugando Medical Centre in Northwestern Tanzania between March 2010 and February 2011. After informed consent to participate in the study, all patients were consecutively enrolled into the study. Data were collected using a pre-tested questionnaire and analyzed using SPSS computer software version 15.0.A total of 1678 road traffic crash victims were studied. Their male to female ratio was of 2.1:1. The patients ages ranged from 3 to 78 years with the mean and median of 29.45 (± 24.22) and 26.12 years respectively. The modal age group was 21-30 years, accounting for 52.1% patients. Students (58.8%) and businessmen (35.9%) were the majority of road traffic crash victims. Motorcycle (58.8%) was responsible for the majority of road traffic crashes. Musculoskeletal (60.5%) and the head (52.1%) were the most common body region injured. Open wounds (65.9%) and fractures (26.3%) were the most common type of injuries sustained. The majority of patients (80.3%) were treated surgically. Wound debridement was the most common procedure performed in 81.2% of the patients. The complication rate was 23.7%. The overall average length of hospital stay (LOS) was 23.5 ± 12.3 days. Mortality rate was 17.5%. According to multivariate logistic regression analysis, patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with long bone fractures stayed longer in the hospital and this was significant (P < 0.001) whereas the age of the patient, severe trauma (Kampala Trauma Score II ≤ 6), admission Systolic Blood Pressure < 90 mmHg and severe head injury (Glasgow Coma Score = 3-8) significantly influenced mortality (P < 0.001).Road traffic crashes constitute a major public health problem in our setting and contribute significantly to unacceptably high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of road traffic crashes is necessary to reduce the mo
Ten-year experiences with Tetanus at a Tertiary hospital in Northwestern Tanzania: A retrospective review of 102 cases
Phillipo L Chalya, Joseph B Mabula, Ramesh M Dass, Nkinda Mbelenge, Stephen E Mshana, Japhet M Gilyoma
World Journal of Emergency Surgery , 2011, DOI: 10.1186/1749-7922-6-20
Abstract: This was a ten-year period retrospective study of patients who presented with a clinical diagnosis of tetanus at Bugando Medical Centre between January 2001 and December 2010. Data was analyzed using SPSS computer software system.A total of 102 patients were studied. The male to female ratio was 11.8: 1. The majority of patients (74.5%) were aged < 40 years and 51.0% of them were farmers. Only 23.5% of patients had prior tetanus immunization. 53.5% of patients had a reasonably identifiable acute injury prior to the onset of tetanus and commonly involved the lower limbs (53.8%). The majority of patients (97.1%) had generalized tetanus. The mean incubation period and period of onset were 8.62 ± 4.34 and 3.8 ± 2.2 days respectively. Complication rate was 54.9%. The average overall duration of hospitalization was 34.12 ± 38.44 days (1-120 days). Mortality rate was 43.1%. According to multivariate logistic regression analysis, the age ≥ 40 years (P = 0.002), incubation period < 7 days (P = 0.014), tracheostomy (P = 0.004), severity of tetanus (P = 0.001) and need for ventilatory support (P = 0.013) were found to be significantly associated with higher mortality.Tetanus remains a major public health problem in our centre and still carries unacceptably high morbidity and mortality despite the available advanced management facilities including ICU care. Young adult males are commonly affected. The incidence of tetanus can be reduced significantly by an effective immunization program and proper wound management of the patients. Early recognition, intense support and prompt treatment improves morbidity and mortality of patients diagnosed with tetanus.Tetanus, though a vaccine preventable disease, is still a significant public health problem throughout the world and it is associated with a high morbidity and mortality rate, particularly in the developing world [1-3]. The global incidence of tetanus is still estimated at one million cases annually, with a case fatality ratio ra
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